STANDING ORDER

CARMARTHENSHIRE ANTIQUARIAN SOCIETY

CYMDEITHAS HYNAFIAETHAU SIR GAERFYRDDIN (Charity No. 260705)

PAYMENT BY STANDING ORDER

Please return to the Society's Treasurer: Terry Wells, c/o Carmarthenshire Archive Service, Parc Myrddin, Richmond Terrace, Carmarthen, SA31 1DS, Tel. 01267 228232, email: twells@carmarthenshire.gov.uk

Please enter below details of your Bank, Branch and Account Number:

To....................................................................................... Bank Ltd,

Bank's Address.......................................................................................................

Bank's Sort Code..........................

Exact Name or Names on your Account.........................................

Your Account No......................................

Please pay the National Westminster Bank Ltd., Carmarthen (Sort Code 5600-42) to the order of the Carmarthenshire Antiquarian Society (A/c No. 02429233) on the first day of January 2012, and every subsequent first day of January until further notice.

The sum of £16 (individual membership) OR The sum of £18 (family membership)

[DELETE AS APPROPRIATE],

this amount being my subscription to the said Society.

This cancels all previous orders to the Society.

Membership No...............................

Signature ................................ Name in full...............................................………

Exact Name of account to be debited......................................……………………

Your Address & Tel. No...............................................................................……..

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